Active NPI
Jessica Tilley, RD, LD
- Registered Dietitian
- Owasso, OK
National Provider Identifier
1013294255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1042
- Practice address
- 8505 N 129TH East Ave
Owasso, OK 74055-7168 - Phone
- (918) 376-2529
- Fax
- (918) 376-2548
- NPI assigned
- Nov 15, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1042 | OK | Primary |
Addresses
Primary practice location
8505 N 129TH East Ave
Owasso, OK 74055-7168
Mailing address
8505 N 129TH East Ave
Owasso, OK 74055-7168
Phone (918) 376-2529
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1042 | OK | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346284800000",
"number": "1013294255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8505 N 129TH EAST AVE",
"city": "OWASSO",
"state": "OK",
"postal_code": "740557168",
"telephone_number": "918-376-2529",
"fax_number": "918-376-2548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8505 N 129TH EAST AVE",
"city": "OWASSO",
"state": "OK",
"postal_code": "740557168",
"telephone_number": "918-376-2529",
"fax_number": "918-376-2548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLEY",
"first_name": "JESSICA",
"name_prefix": "Ms.",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-15",
"last_updated": "2012-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "1042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owasso, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.